Oil Wells Specific Action Permit Application

Page 1

Los Angeles Fire Department

PERMIT

200 N. Main Street, 17th Floor, Los Angeles, CA 90012

Application for Specific Action Permit

Oil Wells

LOCATION INFORMATION Date of Use:

Name:

Date Granted

API: Multiple Use Dates

Address:

Date Expires: PERMIT# 6 Months from date Granted

Phone: State:

Zip Code

City

CONTRACTOR INFORMATION Name:

Phone:

Address: City:

State: Title:

Signature:

Print Name

Zip Code

PROPERTY OWNER / SPONSORING ORGANIZATION Phone:

Name: Address: City:

State:

Print Name:

Signatures:

Zip Code Titles:

** Do Not Write Below This Line ** Inspector Signature:

FIRE MARSHAL

Date:

Unit:

Oil Wells Unit

Permit will not be valid unless signed by Fire Marshal's

Phone#

(213) 978-3598

Billing and Accounts Receivable 16th Flr. Rm. 1620

ITEM

CODE

QTY

FEE

Abandonmnet/Re-Abandonment

388251

$3,610

Vent Cone

388217

$1,444

Fee Exempt

Total Fees:

For Inspector use only:

APPLIANCE TAGGED

FINALIZED INSPECTION shall be forwarded to: Fire Station

LR HR

Unit

NEW

Date of Finalization

EXIST

*Effective 10-10-2023


Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.